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I had a pacemaker inserted into a vein in my chest wall eight years ago. During the past year, my arm on the side where the pacemaker was inserted has become quite swollen. It does not hurt. The swelling gets worse when the arm is down and improves somewhat at night when I am sleeping. Is this caused by my pacemaker?

Answer:

When a pacemaker is inserted, the pacemaker wire that travels from the pacemaker generator into the heart is passed through a vein along the chest wall, down into the chest and then into the heart itself. The wires are fairly thick and over time they can cause inflammation and narrowing of the veins within the chest where they drain into the heart. This can cause a backup of blood in the arm and it can cause the arm to swell. This condition is diagnosed by a variety of tests including ultrasound and also a type of "contrast dye" study called a venogram. If a narrowing of a vein in the chest is identified, it can be treated by stretching the narrowed vein open with a balloon catheter. This can often provide significant relief of the arm swelling. Removing the pacemaker wire from the narrowed vein and moving it to a different vein can sometimes help, but often times the narrowing and scarring of the vein are such that simply removing the wire will not provide enough relief of the swelling. A balloon angioplasty or a stent may be necessary to alleviate the arm swelling.